Leeds Pioneer Programme – Profile

1.1 What is your area like?

Leeds is a city of innovation, drive and ambition which aims to be recognised as the best city in the UK by 2030. It is a large, modern and diverse city with a population of 800,000. Black, Asian and minority ethnic groups make up 18% of the population. General health and deprivation are worse than the national average with 150,000 people living in the most deprived neighbourhoods and with large gaps in life expectancy for both men and women. Obesity and smoking-related deaths in the city are also worse than the national average. Leeds is a city with demographic pressures at the youngest and eldest end of the spectrum, and a vibrant, transient and large student population, which brings further challenges for health and care.

Leeds has a distinctive health and social care ecosystem, bringing together local and national stakeholders from many sectors into a coherent strategic voice to improve health and wellbeing. The partners involved in the pioneer programme include three NHS trusts, one of which is Leeds Teaching Hospitals NHS trust the largest of its kind in the UK, three clinical commissioning groups (CCGs), two universities, the Leeds Institute for Quality Healthcare, private sector providers such as EMIS and TPP who provide the GP record system, and Leeds City Council.

1.2 What are you aiming to achieve?

Our vision is for Leeds to be a healthy and caring city for all ages. For that to happen, responsive person-centred integrated care must become the norm so that Leeds citizens experience high-quality and seamless care as opposed to the fragmented care many currently receive.

Our vision builds on the National Voices’ work and local patient voices of all ages. It is focused on wellbeing, prevention and early intervention for all age groups. We recognise we need to address long-term public health issues to shift and change people’s behaviours about their health and their relationship with local health and care services in order to deliver longer term transformational change as well as impact on the more immediate pressures on hospital and long term nursing home and residential care provision.

Our five asks of the national pioneer programme are designed to support the above, specifically:

- Freedoms and flexibilities: Leeds uses one ‘currency’ flow for money and data across all systems and sectors
- Health economics and analysis: Leeds’ commissioners and providers are confident that current and new models of care deliver fully integrated services improving health outcomes and people’s experiences of care, and benefitting the local health economy
- Risk underwriting: Leeds is an innovative city, leading the way in new models of commissioning and person-centred service delivery for integrated care which ensure the wider system shares in the benefits and risks of transformation and public sector reform • Workforce: A highly skilled, flexible and committed integrated health and social care workforce delivering a quality experience for the people of Leeds • Social marketing: Co-creating a narrative with the people of Leeds to understand the changing nature of services and service usage. This includes understanding what we want to achieve together, why it is relevant, and – most importantly – how it will improve the quality of experience for individuals, families and carers

1.3 What have been the highlights of your first year? • Rolling out the Leeds integrated care record and developing ‘citizen-driven health’. One important aspect of this is making health and care records digital. Leeds is a leader in this area of work. Currently around 87% of GP surgeries have access to the Leeds integrated care record, along with the hospital, including A&E. In time, this will be extended to local NHS and social care services and ultimately to individual patients • Development of integrated neighbourhood teams across the city • Launching the Leeds Innovation Health Hub and potential for the Leeds Intelligence Hub to develop innovative solutions and enable system change • Leeds Assistive Living Hub is the new one-stop centre that houses a range of specialist services to support people with physical, learning and care needs to live safely and independently. The centre provides one place to find information and advice on what type of equipment and other assistive technology is available in Leeds. Leeds City Council is running the scheme in partnership with the NHS

1.4 Details of the year 1.4.1 Priorities for the transformation and pioneer programme The following diagram sets out priorities for the five-year pioneer programme, which is discussed in more detail below. 1.4.2 Innovation: Leeds Innovation health hub

The Leeds Innovation Health Hub was recently established to identify and drive innovation across all public and private partners and sectors, to support the transformation of frontline services. Leeds is working to become a ‘Smart City’ which maximises the potential of all its assets and resources to contribute to better lives and economic prosperity. This includes improving health, care and wellbeing outcomes by developing innovative technology based solutions.

An example of innovation is our push towards ‘citizen-driven health’ which seeks to use technology more innovatively to help people maximise their health and independence. See case study: testing models for ‘citizen-driven health’. As part of the pioneer programme, we have also taken a leading role in a number of national informatics developments including:

- Leeds has volunteered to lead the informatics pioneer network and programme on behalf of the pioneer community, formed to identify barriers and drive improvements both locally and nationally. This network brings together local informatics leads and those from national NHS and other organisations including NHS England, Health and Social Care Information Centre, SOCITM, Local CIO Council, ADASS Informatics Network, and NHS IQ to collaborate on the innovative use of technology to improve outcomes and enable greater integration of health and social care. The pioneer informatics programme includes eight projects that all pioneers are collaborating on delivering to work as one with national health organisations to remove barriers to integration and develop simplified and shared solutions to be used by all and the learning from which disseminated to all areas of the country
- Representing the pioneers as a member of the National Informatics Board, ensuring a link between local pioneer work and national policy and strategy development
- Leeds is a pilot for the Care.Data programme
- Leeds has worked closely with Monitor to publish a guide to creating linked data sets

1.4.3 Commissioning: The Leeds Pound

To bring a sense of common purpose and to underpin partnership working, we have developed over recent years the concept of the ‘Leeds Pound’. This is a move away from historic practices where each organisation works in isolation on how they spend their individual budget towards thinking of these budgets as the collective budget of the city and how this can collectively be directed to meet the needs of the people of Leeds. This work builds on a strong recent history of successfully delivering shared outcomes through pooled budgets within the Leeds health and care system.

As part of this, we are working to enhance our health economics to better understand the needs of Leeds citizens now and in the future, and how we can most effectively address them as a whole system. We are continuing to work closely with NHS England, Monitor and the Leeds Early Implementer for Year of Care pilot to further develop and test our capability and capacity to analyse and model the current and future financial and economic needs of our local health economy.

1.4.4 Delivery: Building high-quality, easily accessible community provision

Called ‘Better Lives through Integration’, this adult social care led programme recognises the need to wrap community services around individuals, their families and carers, to provide a seamless quality experience. This programme is part of a whole systems approach which includes high-quality integrated health and care services. These include Leeds neighbourhood networks which are community based, locally led schemes that enable older people to live independently, and proactively participate within their own communities by providing services that reduce social isolation, provide opportunities for volunteering, act as a gateway to advice, information and services to promote health and wellbeing, and thus improve the quality of life for the individual. See case study: Developing an integrated community health and social care service.

We have also continued to invest in community based provision to support a shift away from hospital and emergency care. One recent highlight has been the opening of the South Leeds Independence Centre in April 2013 by Leeds City Council, Leeds South East CCG and Leeds Community Health Trust respectively. It is a jointly commissioned and provided intermediate care centre in a community setting designed to provide reablement and rehabilitation to enable people to spend less time in hospital. Our ambition over the next five years, through continuous evaluation and learning from elsewhere, is that the people of Leeds will be able to access further community facilities of this nature.

1.5 What has been the most exciting aspect?

Leeds is proud of the work it has undertaken within the pioneer programme and nationally to chair the informatics and information governance agenda. We are delighted to build on the work of the Leeds care record by leading on the integrated digital care record project across the pioneers that will collaboratively develop shared requirements, approaches and standards for all care record solutions across the country.

1.6 What has been the most challenging aspect?

Leeds was excited and delighted about being awarded pioneer status. In its first year performance against these has been mixed, in part because the national pioneer support offer took longer than anticipated to mobilise and demonstrate a full understanding of our needs. The offer is now under review. For example it has recently proved valuable to have a manager seconded from the Department of Health to bridge local and national perspectives.

Some issues remain, however, particularly on information sharing, but we will continue to influence this agenda through active participation in the pioneer support group.

1.7 What are you planning to do next year? • Re-examine the role of the pioneer programme in order to more closely align it with the Year of Care pilot and the Forward View implementation and new models of care • Roll out our new approaches to informatics and reinforce Leeds’ reputation as a digital city • Further develop our work on the ‘Leeds Pound’ with NHS England and local universities • Develop further our integrated neighbourhood teams capacity across the city. See case study: Developing an integrated community health and social care services – development and evaluation • Through the Year of Care pilot establish models of care and payment systems for 2016/17 and beyond • Develop a city-wide health and wellbeing communications and engagement framework. This will involve work to better understand the levers for behaviour change such as people appropriately accessing A&E, and to communicate major reforms such as new care models • Develop our proposals for devolution seeking a more resilient, sustainable local economy that is better able to meet the long-term health and other needs of Leeds citizens

1.8 What is your advice for areas starting on their own integration journey?

Our top tip is transformation and reform require long-term solutions and relationships and success will not happen overnight, even if you are a pioneer site. The expectations of the Leeds pioneer programme and nationally have been very high, and at times this has been a challenge for Leeds and national partners. We continue to remain optimistic. For 2015/16, we have recognised the benefits the first year of the pioneer programme has generated for Leeds and are refreshing our ambitions for 2015-2020, with all key partners.

We recognise that there is much learning to be gained from working closely with other sites. We are seeking to build on an informal partnership that has existed between Leeds, Greater Manchester and North West London since 2013. We are now looking to establish this as a formal learning network sponsored by the pioneer programme, and it is anticipated that the first meeting will commence in February 2015, with input from the King’s Fund where possible.

Contact: Damon Palmer Email: leeds.integrationpioneers@leeds.gov.uk

Web link: http://www.leeds.gov.uk/residents/Pages/Health-and-social-care-integration.aspx